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PubMed2005

Mandatory continuing education in physical therapy: survey of physical therapists in states with and states without a mandate.

BACKGROUND AND PURPOSE: Although formal continuing education (CE) in physical therapy is one part of professional development, its value for renewing licensure is not shared by all states. The purpose of this study was to explore the differences in how physical therapists pursue formal continuing education on the basis of state mandate, sex, years of experience, practice specialty, American Physical Therapy Association membership, motivation, and perception of the benefits of CE. SUBJECTS AND METHODS: A survey questionnaire was sent to 3,000 physical therapists in 7 states--1,500 to physical therapists in states with mandatory CE and 1,500 to physical therapists in states without a requirement. A total of 1,145 usable survey questionnaires were returned, for a response rate of 38.2%. RESULTS: Physical therapists in states with mandatory CE averaged 33.8 hours of CE per year, whereas physical therapists in states without a mandate averaged 28.3 hours per year; 5.9% of therapists in states without a mandate reported taking no CE at all, and 10.8% reported taking 2 or fewer hours of CE within the preceding 5 years. No statistically significant relationships were observed between the amount of CE taken and years of experience, sex, or practice specialty. Therapists who reported membership in the American Physical Therapy Association participated in 7.2 more hours of CE per year than therapists who did not report membership. Significant motivational variables that respondents noted for taking CE were state mandate, increased clinical competence, and certification. Therapists overwhelmingly (96.2%) believed that CE had a beneficial effect on their clinical practice. DISCUSSION AND CONCLUSION: Results from this study suggest that mandatory CE does have a significant association with the number of formal CE hours taken by physical therapists.

Attitude of Health Personnel↗
PubMed1987

The total assessment of rheumatoid polyarthritis--evaluation of a training program for physiotherapists and occupational therapists.

We evaluated a training program for physiotherapists and occupational therapists in the total assessment of patients with rheumatoid polyarthritis. Close agreement was seen between the active joint counts of the rheumatologists and 36 therapists (p2 = 0.23). In the 7 quality variables for bedside case workups, a statistically significant learning effect was seen over the 6 week period (p2 = less than 0.005). In the 10 quality variables for the case presentations at Week 6, judged at the graduate medical trainee level, mean global scores achieved were 72.5%. Therapists reported a high level of satisfaction with all components of the program.

Arthritis, Rheumatoid↗
PubMed2002

The relationship between type of degree and professional status in clinical music therapists.

The purpose of this descriptive study was to: (a) examine the relationship between the construct, Type of Music Therapy Degree, and 5 other constructs: Job Satisfaction, Job Longevity, Level of Promotion, Job Responsibilities, and Geographical Location; and (b) explore the interrelationships among the 5 constructs other than Type of Music Therapy Degree. Questionnaires were mailed to 616 clinical music therapists. The response rate was 35% (N = 218). Ten variables defining the 6 constructs were examined for statistically significant and meaningful relationships: highest music therapy degree achieved, average job satisfaction rating, length of time as a music therapist, length of time in present job, average length of time in jobs, total number of jobs, total number of promotions across jobs, number of present duties, number of hours presently working, and region in which work. Results indicated that a significant relationship existed between highest music therapy degree achieved and 3 variables: length of time as a music therapist, total number of jobs, and region in which work. Follow-up comparisons revealed that those respondents with a Doctoral Degree had been employed at significantly more jobs than those with a Bachelor's degree. Also, those with a Master's degree in music therapy had stayed significantly longer in the field than those with a Bachelor's degree in music therapy. A follow-up analysis with the third variable, region in which work, indicated that the highest proportion of respondents in each region had obtained a Bachelor's degree in music therapy. Of the 8 significant relationships obtained among the other 9 variables, 4 variables defining the construct Job Longevity appeared to play a central role in the relationships among the variables.

Educational Status↗
PubMed1976

Psychological differentiation and psychotherapy.

Patient's level of psychological differentiation was studied in relation to patients' and therapists' evaluations of the initial psychotherapy session. The evaluations assessed two broad dimensions of the interaction which generally have been considered important for psychotherapeutic success and which have been found to be related to patients' psychological differentiation: namely, patients' and therapists' satisfaction with the amount of structure, and therapists' impressions of patients' appropriateness for therapy. Significant correlations were obtained between patients' psychological differentiation and both of these dimensions. However, two control variables, socioeconomic status and alcohol use, were also found to be related to these dimensions. When the effects of these variables were partialed out, the relationships with therapists' impressions of appropriateness disappeared, but the relationships with patients' and therapists' satisfaction with the amount of structure remained significant. The relationship of these findings to other studies of psychological differentiation and psychotherapy is discussed. Finally, the contribution of the present results to the choice of the most appropriate measure of psychological differentiation is noted.

Adult↗
PubMed2005

What predicts a good response to cognitive remediation interventions?

Cognitive remediation is a behavioral intervention designed to improve cognition in people who have suffered a decline in neuropsychological functioning. The application of cognitive remediation for people with schizophrenia has become increasingly popular. In this article we attempt to determine what factors moderate outcome in cognitive remediation. This issue is of primary concern, as the efficacy of treatments largely depends on the appropriate selection of individuals and treatment methodologies that are most likely to yield gains. Three databases were examined, dividing the samples into participants who showed or did not show a marked improvement from baseline to posttest. We examined patient, illness, and treatment factors that might affect treatment response. Whereas certain patient and treatment variables did differentiate "Improvers" from "Nonimprovers," illness factors were the least likely to influence treatment outcome. Treatment intensity, type of cognitive remediation program, and therapist qualifications were identified as key treatment variables. Patient levels of motivation for treatment and baseline sets of work habits were also important moderators. While the issue of treatment intensity appears to be especially salient, there is evidence that to some extent patient and treatment variables intertwine to produce a positive response to cognitive remediation.

Cognition Disorders↗
PubMed1998

How do clinicians respond to patients who miss appointments?

BACKGROUND: Although patients miss up to 60% of scheduled outpatient appointments, little is known about how clinicians respond to "no-shows." In an effort to determine how clinicians customarily handle missed appointments, we surveyed mental health clinicians and internists at 2 academic hospitals: a private psychiatric hospital and an urban general hospital. METHOD: An anonymous questionnaire survey was mailed to psychiatrists, psychologists, and social workers at both hospitals and to internists at the general hospital. Clinicians were surveyed about their usual response to psychotherapy, psychopharmacology, and internal medicine patients who miss appointments. RESULTS: Among the 356 responses (39.5%) to 902 mailed questionnaires, there was substantial variability in clinicians' reported handling of "no-show" patients, although psychiatrists tended to be initially less active in pursuing patients than were nonphysician therapists and internists. A number of clinical variables were associated with clinicians' responses including the perceived risk of a bad outcome, hospital site, support staff availability, and billing practices. CONCLUSION: The results suggest that clinicians' responses to missed appointments are determined by a complex mixture of influences rather than adherence to a readily definable "standard of care."

Adult↗
PubMed1996

Systematic effects of participant role on evaluation of the psychotherapy session.

This study identified systematic differences between therapists (n = 114) and patients (n = 119) in the process components that predict evaluation of psychotherapy sessions. The Comprehensive Scale of Psychotherapy Session Constructs was developed to measure 9 process variables and their relationships to session evaluation from the perspectives of therapist and patient. Regression equations predicting session evaluation from the process components for the 2 groups were significantly different. Therapist session evaluation was best predicted by therapist expertness, and patient session evaluation was best predicted by the therapist real relationship. The therapist real relationship negatively predicted therapist session evaluation when all process variables were considered simultaneously. Patient progress and patient involvement significantly and positively predicted both therapist and patient evaluation.

Adult↗
PubMed1997

Burnout in orthopaedic physical therapists.

Few studies exist about burnout in physical therapists. No research is available on burnout in orthopaedic therapists. The purpose of this study was to determine if burnout exists in this group and if a relationship exists between burnout scores and selected variables. Members of the Orthopaedic Section of the American Physical Therapy Association from the east north central region of the United States were sent a survey consisting of demographic questions and the Maslach Burnout Inventory. The return rate was 38.7%. Burnout levels were low to moderate depending on the grouping used to examine the data. All of the variables examined (eg., years as a physical therapist, number of patients seen per day) showed very low correlations with subscale scores. Further research is needed to identify those at most risk for burnout and to find effective strategies for its prevention.

Adult↗
PubMed1993

Exploring multicultural competencies of occupational therapists: implications for education and training.

The purpose of this investigation was to explore the influence of demographic and educational variables on self-reported multicultural competencies of occupational therapists. A sample of 94 occupational therapists currently working in the field participated in this investigation. Multicultural course work, seminars and workshops, percentage of minority patients worked with, and highest degree held were found to correlate significantly with self-reported multicultural competencies. Regression analyses found that highest degree held, percentage of minority patients worked with, multicultural course work, and participation in multicultural seminars and workshops accounted for about half of the variance in multicultural awareness. These findings are discussed in terms of academic courses and continued professional training and education for occupational therapists.

Adult↗
PubMedDate not supplied

Expert opinion in the identification of variables for the measurement of early recovery in adults with traumatic brain injury.

The expert opinion of 27 experienced physical therapists was systematically sought using a modified Delphi technique in order to identify the important variables to be included in the neurophysical evaluation of the traumatic brain-injured (TBI) adult during the acute stage of rehabilitation (first 3 months). An initial survey of the therapists generated 63 items which were later regrouped into 23 categories. Each category was then rated using a five-point scale (1 = of no importance to 5 = extremely important) by each therapist as to its importance in the early clinical neurophysical evaluation of the TBI patient. Those variables identified as extremely important by at least 50% of experts include: state of consciousness, voluntary movements, spontaneous movement and transfers. The results of this study highlight, for physical therapists and other health professionals, the important variables to be included in the evaluation of neurophysical deficits in persons with TBI in the acute stage of rehabilitation.

Adult↗
PubMed2004

The core variables of symbolic-experiential therapy: a qualitative study.

Symbolic-experiential therapists have been criticized for not adequately operationalizing symbolic theory and empirically validating their methods. Although pioneering researchers have noted that the task of studying and evaluating humanistic therapies is complex, we agree that all therapists need to be held accountable for their interventions. In this article we identify the core variables underlying symbolic-experiential therapy that emerged from a research study using grounded theory. The inductively derived conceptual framework for symbolic-experiential therapy included: (a) Generating an interpersonal set; (b) creating a suprasystem; (c) stimulating a symbolic context; (d) activating stress within the system; (e) creating symbolic experience; and (f) moving out of the system.

Family Therapy↗
PubMed2002

Reflections on gifts in the therapeutic setting: the gift from patient to therapist.

Since Freud's time, psychoanalytically oriented therapists have been wary of accepting gifts from patients, although they have done so in some circumstances within the sanctum of their offices. After providing a working definition of the word "gift" for the purposes of this clinical discussion, the article reviews the relevant literature on the subject. The author presents clinical material in which he describes how gifts were presented by patients within the context of their treatment processes. The article concludes with the author's attempt to define some of the variables that affect the response of the therapist to a patient's gift, and expounds on those variables in terms of their influence on technique.

Adult↗
PubMed2000

Effects of using recommended coping strategies on drinking outcome following a brief intervention.

AIMS: To explore the unique contribution to outcome drinking of clients' use of six strategies for moderating drinking, after statistically accounting for variance explained by some client and intervention variables. DESIGN: An exploratory hierarchical regression analysis assessed the contributions to variance in drinking outcome of pre-intervention (client characteristics, baseline drinking), assignment (level of assessment, therapist experience) and early follow-up variables. Data came from an experimental trial which evaluated the effect of adding assessment to provision of a self-help book to heavy drinkers. SETTING: Diverse Ontario communities. PARTICIPANTS: Heavy drinkers (99 males, 56 females) were selected from 185 media-recruited applicants who were screened by telephone to exclude cases with severe alcohol-related problems. Their mean (+/- SD) pre-admission weekly quantity of alcohol consumed was 22 +/- 15 drinks. Follow-up rates at 3 and 12 months were 92% and 88%. MEASUREMENTS: Regressed onto weekly quantity at follow-up were: client characteristics, previous measures of weekly quantity, experimental condition and use of the menu of strategies (setting goals for drinking, keeping track of drinking, pacing drinking, planning ahead to avoid heavy drinking, developing free-time activities and coping with problems without drinking). FINDINGS: At 3 months the variables predicting lower weekly quantity were: pre-intervention weekly quantity, developing free-time activities, setting goals for drinking and condition. Lower weekly quantity at 12 months was predicted by lower 3-month and pre-intervention weekly quantity, and regular use of: coping with problems without drinking, setting goals for drinking and keeping track of drinking. CONCLUSIONS: This descriptive study revealed a positive association between level of use of recommended coping strategies at follow-up and drinking outcome. Controlled studies of the effects of strategy use on drinking outcome are therefore warranted.

Adaptation, Psychological↗
PubMed1983

Effects of instruction in basic communication skills on physical therapists and physical therapy students.

The purpose of this study was to test the hypothesis that laboratory instruction within a one-semester course could significantly change the communication skills of physical therapists and physical therapy students in the desired direction. Effective use of communication skills, the dependent variable, is defined in the counseling psychology literature. The independent variables were parts of two academic courses for physical therapists: one for graduate students (physical therapists) and one for undergraduate students. Data from the two groups were treated separately in a one-group, pretest-posttest, quasi-experimental design. The test for overall effect of changes in communication skills of undergraduate students was significant at the .0001 level. Post hoc tests for changes in use of seven specific skills varied in significance level from .8 to .0001. Education techniques, not subject variability, accounted for most of the change. Graduate student data did not reach traditional significance levels, but encouraging trends were noted. Results can be interpreted in terms of education, clinical experience, and measurement tools.

Adult↗
PubMed1984

Construct validation of occupational therapy measures used in CVA evaluation: a beginning.

A factor analysis was conducted that involved 33 variables from data on 100 acute cerebral vascular accident patients evaluated by occupational therapists at the St. Marys Hospital Medical Center, Madison, Wisconsin. Variables included the Brunnstrom arm and hand recovery stages, bilateral grasp and pinch measures, bilateral tests of coordination, a number of perceptual tests, and five measures of self-care. From interpretation of the rotated factor patterns, five factors were defined: self-care, left function, recovery stage, perception, and strength. The results provide evidence for the construct validity of the St. Marys CVA battery, although corroborative studies are needed.

Activities of Daily Living↗
PubMed1982

Reliability in evaluating passive intervertebral motion.

Reliable measurements are prerequisite to the successful conduct of outcome studies. In a study of the performance of physical therapists (n = 5) in evaluating passive mobility of the vertebral column with normal subjects (n = 5), several sources of measurement variability were assessed: the reliability within and between therapists, the criteria for grading, and the subjects themselves. Intratherapist reliability was found to be dependable; intertherapist reliability was not. Problems that merit further study were identified as idiosyncratic behaviors that may develop with experience, subject characteristics, and the instrument itself. Periodic assessment of the reliability of therapists in performing evaluations is recommended because of its importance to therapeutic programming.

Clinical Competence↗
PubMed2001

Respiratory therapists and critical-thinking behaviors: a self-assessment.

The purpose of this study was to assess critical-thinking behaviors of respiratory therapists through self-report. Using a quantitative survey research method, respiratory therapists rated themselves on seven critical thinking skills. The effects of personal variables on the self-assessments were also investigated. The respiratory therapists self-assessed their critical-thinking behaviors highest in the categories of prioritizing, troubleshooting, and communicating. Anticipating was self-assessed as the lowest-ranked critical-thinking behavior. Age and educational level were found to have no effect on the self-assessed behaviors, while years of experience in respiratory care and gender were found to affect self-assessed troubleshooting, decision making, and anticipating. The results of this study suggest that educators and clinicians should consider learning strategies that incorporate the use of experience when targeting novice practitioners.

Adult↗
PubMed1998

Accuracy of observational kinematic assessment of upper-limb movements.

BACKGROUND AND PURPOSE: This study investigated the accuracy of physical therapists' visual judgments about kinematic features of the upper-limb movements of people without neurological impairments and people with neurological impairments following a cerebrovascular accident (CVA). SUBJECTS: Ten experienced physical therapists served as observers. Eleven people with a primary diagnosis of cortical or subcortical CVA and 4 older individuals without neurological impairments participated as "performers." METHODS: The performers were videotaped as they completed a transport task. Three videotapes were edited to form three physical scales of peak movement speed, jerkiness, and hand path indirectness. On two occasions, therapists viewed these videotapes and made judgements about each performance on visual analog scales. Therapists' visual judgments were then compared with criterion measures determined by three-dimensional instrumented analysis. RESULTS: The accuracy of the therapists' judgments was investigated using regression methods. Therapists were able to make moderately to highly accurate judgments of movement speed (r > or = .87), jerkiness (r > or = .78), and hand path indirectness (r > or = .68). These judgements remained highly stable over time (r > or = .82). Differences in therapists' judgement models, evident from slope and intercept variability in the regression models, were reflected in lower intertherapist agreement (intraclass correlation coefficients = .65-.85). CONCLUSION AND DISCUSSION: Experienced physical therapists accurately and reliably judged kinematic aspects of performance using observational assessment. Observational kinematic assessment warrants further systematic investigation.

Aged↗